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General NPI Number Information
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NPI Number | 1821083015
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Entity Type | Individual
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Provider Name | BURKE E HANSEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/14/2005
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Last Update Date | 10/22/2020
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Provider Practice Location Address
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Address Line | 30 MT HIGHWAY 91 S SUITE 204
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City | DILLON
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State | MT
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Zip | 59725-3535
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Country | US
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Telephone | 406-683-4252
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Fax | 406-683-9403
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Provider Business Mailing Address
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Address Line | 30 MT HIGHWAY 91 S SUITE 204
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City | DILLON
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State | MT
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Zip | 59725-3535
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Country | US
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Telephone | 406-683-4252
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Fax | 406-683-9403
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 10081
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License Number State | MT
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